Weak points in AIDS care

11th August 2008

The World Health Organisation (WHO) and the World Bank have announced they will collaborate on a new international health initiative to combat HIV/AIDS, as the UN agency issued a new package of priority interventions for the disease and related social problems.

Rather than investing new funds into HIV treatment and prevention, the WHO-World Bank collaboration will examine and combine the strengths of different approaches around the world in order to get better results from existing investments.

Julian Schweitzer, Director of Health, Nutrition and Population at the World Bank said he hoped the project would generate new knowledge, as well as working with countries to improve their approaches and share lessons at the regional and global levels.

Weaknesses in overstressed health systems in many low- and middle- income countries are thought to be limiting the effectiveness of a series of global health initiatives launched in recent years. The new project will examine the issues and provide governments with sound technical guidance.

Carissa Etienne, WHO Assistant Director-General, Health Systems and Services said the time had come to move from observing the intentional and unintentional impacts of health investments, to actively managing better, and sustainable, outcomes.

Meanwhile, WHO's HIV/AIDS Department Director, Kevin De Cock launched a new priority interventions document during the International AIDS Conference in Mexico.

The document sets out priority health-sector HIV/AIDS interventions that are needed to achieve universal access to HIV prevention, treatment and care and provides guidance to governments in prioritising HIV prevention, treatment and care strategies.

WHO Director-General Margaret Chan said the increasing prevalence of HIV among girls and women was a particular challenge.

"In the context of this epidemic, many of these issues place women in a disadvantaged position, increase their risk of infection, and reduce their access to services, including those providing treatment," Chan told delegates.

"Unfortunately, in far too many cultures, women are still regarded as the second sex, the weaker sex, the junior partner in male-and-female relationships, in household decisions, and usually in decisions about sexual relationships as well," she said.

Chan called for a change in the attitudes and norms that place women at added risk from HIV.

"Globally, it is nearly always groups and coalitions of women who take this task on their shoulders and get the best results," she said. "Much can be done at the policy level. In cases where discrimination is institutionalised, laws need to be changed."

She called on women to keep up the pressure on politicians to effect lasting change.

According to Chan, in 2007, an estimated 18% of pregnant women in low- and middle-income countries received an HIV test, compared with only 10% in 2004. At the end of 2007, the percentage of all HIV-infected pregnant women receiving medicines to prevent transmission to their infants reached 33%. This is a substantial increase compared with only 10% in 2004.

"But...far too few women are being treated for their own sake, for their own health. Women are important in their own right, as individuals, and not just as vessels or vehicles for reproduction," she said.